| Idaho Dental Anesthesia Pllc | |
|
37 W Archerfield St Ste 100 Meridian ID 83646-6587 | |
| (208) 391-2894 | |
| Not Available |
| Full Name | Idaho Dental Anesthesia Pllc |
|---|---|
| Speciality | Dentist - Dentist Anesthesiologist |
| Location | 37 W Archerfield St Ste 100, Meridian, Idaho |
| Authorized Official Name and Position | Ryan W Judd (DENTIST ANESTHESIOLOGIST) |
| Authorized Official Contact | 5036799797 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Idaho Dental Anesthesia Pllc 37 W Archerfield St Ste 100 Meridian ID 83646-6587 Ph: (208) 391-2894 | Idaho Dental Anesthesia Pllc 37 W Archerfield St Ste 100 Meridian ID 83646-6587 Ph: (208) 391-2894 |
| NPI Number | 1629470141 |
|---|---|
| Provider Enumeration Date | 09/17/2014 |
| Last Update Date | 08/12/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629470141 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0004X | Dentist - Dentist Anesthesiologist | D-4613 (Idaho) | Primary |
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